Common Names: Ephedra, Chinese ephedra, Ma Huang

Botanical Name: Ephedra sinica

Background

• Ephedra is a small, evergreen plant known for its thin, jointed stems and small, scale-like leaves. It is most commonly sourced from the stems and branches of Ephedra sinica.

• Traditionally used in countries such as China and India, ephedra has been utilized to help relieve symptoms like colds, fevers, headaches, nasal congestion, coughs, and breathing difficulties like wheezing.

• In 2004, the U.S. Food and Drug Administration (FDA) prohibited the sale of dietary supplements made with ephedrine alkaloids, compounds naturally found in Ephedra sinica and other similar plants. Before this regulation, ephedra was widely marketed for weight loss, increased stamina, and physical performance enhancement.

How Much Do We Know?

• Since the ban of ephedrine alkaloid supplements, scientific interest in studying ephedra’s effects in humans has dwindled. Most of the available information is based on earlier research done when ephedra-containing products were still available on the market.

What Have We Learned?

• Research before the ban suggested that products combining ephedrine with caffeine could result in a small, temporary reduction in weight. However, this benefit carried considerable health risks. Long-term weight loss results were not studied, and the effect on physical performance was unclear due to insufficient evidence.

What Do We Know About Safety?

• The FDA banned dietary supplements containing ephedrine alkaloids due to severe health risks. Even at low doses and brief exposure, ephedra has been associated with adverse outcomes such as high blood pressure, strokes, seizures, heart attacks, and mental disturbances. These effects can be disabling or even result in death.

• Users have also reported less severe but still concerning side effects, including anxiety, headaches, dizziness, dry mouth, heartburn, difficulty sleeping, irritability, nausea, and changes in personality.

• Currently, it is difficult to predict exactly who may face the highest risks when using ephedra, though combining it with other stimulants like caffeine is a cause for concern. Individuals with cardiovascular conditions are considered especially vulnerable.

• Ephedra is considered dangerous during pregnancy and breastfeeding and is not recommended for children.

Keep in Mind

• It’s important to actively participate in decisions about your health. Speak with your healthcare providers about any alternative or complementary health practices you’re considering. Together, you can make informed choices.

• Herbal products are regulated inconsistently depending on their components, their intended use, and how they are consumed—by mouth or applied on the body. Many herbs, when taken by mouth, are sold as dietary supplements, which are subject to different, often less stringent, regulations compared to pharmaceuticals.

• Dietary supplements do not need FDA approval before being sold. However, if safety problems emerge, such as harmful effects from a particular ingredient or herb, the FDA can act to protect public health. The responsibility for ensuring the safety and proper labeling of supplements falls to the manufacturers and distributors before products reach consumers.

For More Information

• Making Smart Choices About Dietary Supplements

• Understanding Interactions Between Medications and Supplements

• How to Interpret Scientific Articles

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Office of Dietary Supplements (ODS), NIH

The ODS works to enhance understanding of dietary supplements by supporting studies, summarizing research, and producing public resources such as fact sheets on commonly used ingredients like vitamin D and multivitamins.

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Key References

• Ephedra information – NatMed Pro. Accessed September 27, 2023.

• Maunder A et al. Review of herbal medicines for weight management. Diabetes, Obesity and Metabolism. 2020;22(6):891–903.

• Shekelle PG et al. Meta-analysis on the uses and risks of ephedra and ephedrine for weight loss and exercise performance. JAMA. 2003;289(12):1537–1545.

• Thurn AL, Betz JM. Section on Ephedra. In: Encyclopedia of Dietary Supplements. 2nd Ed. Informa Healthcare; 2010:250–255.

• U.S. FDA. Final rule declaring ephedrine alkaloid dietary supplements unsafe. Federal Register. 2004;69(28):6788–6854.

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Note: This content is for informational purposes only and does not replace professional medical advice. Discuss health decisions with your healthcare provider. Mentioning specific products or therapies does not imply endorsement by NCCIH.